A guide to stop-loss insurance - includes related article

Business & Health, May, 1990 by Joyce Frieden

Role of government

As in most industries, stop-loss providers are constantly alert to intrusions by government. Recently, the U.S. Department of Labor has taken an interest in self-insured firms, especially when it comes to their fiduciary duties under the Employee Retirement Income Security Act to provide the best possible deal for health plan participants.

Many have control

"Officially, it's been the health plan trustees" who are said to have that fiduciary duty, but the Labor Department recognized a few years ago that a lot of people, including TPAs and stop-loss plans, have some control over the health plan, Hunt says.

Because of this new government scrutiny, TPAs and in-house administrators are doing more shopping around for stop-loss policies to make sure they've fulfilled their fiduciary responsibilities by getting the best possible carrier.

The federal government, a multitude of carriers, and complex policies can make shopping for a stop-loss plan a stressful experience. But with the help of a resourceful TPA or in-house administrator and some good advice, employers should be able to determine which stop-loss approach is the best for their company.